Personalized Presurgical Nasoalveolar Molding in Cleft Lip and Palate Care: A Seven-Year Single-Center Study

Background: Nasoalveolar molding (NAM) is a presurgical orthopedic treatment used in patients with cleft lip and palate (CLP) to reduce cleft dimensions, reposition the protrusive premaxilla, and improve nasal cartilage shape. Because each appliance is custom-made and adjusted to the individual cleft morphology and response, NAM can be regarded as a personalized, patient-specific intervention. This study aimed to evaluate changes in alveolar and lip gaps, as well as columella and nasal symmetry, following presurgical dentofacial orthopedics with NAM. Methods: This retrospective, single-center study included patients with CLP treated between 2016 and 2022. NAM was performed according to a locally designed protocol. Changes in alveolar and lip gaps, columella and nasal symmetry, and esthetic outcomes were assessed before and after treatment. Results: Nineteen patients who initiated NAM at a median age of 4 weeks were included. Cheiloplasty was performed at a mean age of 18 weeks using the Millard technique, followed by palatoplasty at a median age of 13 months. Significant reductions were observed in lip gap (n = 8), from 1.43 ± 0.81 to 0.63 ± 0.47 cm (p = 0.007), and alveolar gap (n = 14), from 1.47 ± 0.54 to 0.96 ± 0.48 cm (p = 0.001), corresponding to reductions of 56% and 34%, respectively. Nasal asymmetry was observed in 37% of patients, while an asymmetric columella and/or philtrum was identified in 10.5%. Compliance was high, with only one treatment withdrawal. Conclusions: NAM appears to be a feasible approach, with significant reductions in lip and alveolar gaps observed after treatment, and no serious treatment-related adverse events observed in this cohort. Its potential benefits on nasal and columellar morphology could not be separated from the effect of surgery and warrant further investigation in larger prospective studies using objective assessment methods. These findings support NAM as an individualized component of cleft care, in which the indication, timing of nasal stent application and treatment duration should be tailored to each infant and family.